Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1053786665 |
---|---|
Provider Name | Patrick Froelich |
First Address | Champaign, IL 61820-4910 |
Second Address | Champaign, IL 61820-4910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2015 |
Last Update Date | 08/12/2015 |